Evaluation of Maxillary Bone Dimensions in Specific Areas for Removable Dentures

Home , Maxilla, Maxillary tuberosity

https://doi.org/10.5272/jimab.2017232.1527 Journal of IMAB Journal of IMAB - Annual Proceeding (Scientific Papers). 2017 Apr-Jun;23(2): ISSN: 1312-773X https://www.journal-imab-bg.org Original article

EVALUATION OF MAXILLARY BONE DIMENSIONS IN SPECIFIC AREAS FOR REMOVABLE DENTURES Original Articles Dobromira Shopova1, Tanya Bozhkova1, Dian Slavchev1, Spas Muletarov2, Zdravka Ivanova3, Elena Bozhikova2 1) Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University - Plovdiv, Bulgaria; 2) Department of Anatomy, Histology and Embryology, Medical University - Plovdiv, Bulgaria; 3) Department of Plant Physiology and Molecular Biology, Plovdiv University - Plovdiv, Bulgaria.

ABSTRACT similar studies for quantitative evaluation module of elas- Background: Removable prosthetics is a big part of ticity and hardness in different anatomical regions, and Prosthetic Dentistry. Prosthetic field is very important for they were established middle level in frontal area and low successful treatment with partial or complete dentures. in distal zone [3, 4, 5]. The cortical density can be meas- Maxillary bone is covered with soft tissues, but its anatomy ured by Hounsfield units (HU). The investigations proved is essential for retention, chewing stability and comfort of various levels in cortical and cancellous bone densities. the patients. Maxillary tuberosity showed the lowest level [6]. Com- Purpose: The study’s aim was to evaluate the dimen- puted tomography’s study of the edentulous posterior max- sions of maxillary bone in specific zones for removable illae showed porous cortical crest or no cortical bone, al- dentures. though the bone densities varied markedly among indi- Methods: Sixteen craniums were measured in 10 dif- viduals [7]. Micro-computed tomography (microCT) is a ferent zones. It was used an Electronic Digital Caliper 0- method to image and quantify bone with very high resolu- 150 mm. tion [8]. Another investigation for determining the cortical Results: Consistently were applied F-test and Welch thickness, density and elastic properties, proved a big vari- t-test for equality of variance and group’s comparison mean, ability in different areas of the upper jaw [9]. respectively. The spread of the data was described by cal- Physical properties of the bone are related to culating range and standard deviation. The estimated value resorption. The marginal bone level was, on average, 1.0 of range was highest in the FI-A1P, followed by FI-AC and mm less from the implant/abutment junction after 1 year FI-A2P. The smallest amplitude was established in the TM- [10]. Resorptive process can be considered from the length PP and SNA. The estimated value of standard deviation was of incisive canal, which is different value in dentulous and 2,57/2,51 in FI-AC zone, 2,46/2,59 in FI-A1P zone and a edentulous maxillary bone [11]. It is established gender dif- few smaller 2,08/2,13 in FI-A2P zone. The lowest values ference in anatomic features of incisive canal [12]. Monje were in TM-PP and SNA areas. proved a statistically significant positive correlation be- Conclusion: Tuber maxillae and Spina nasalis ante- tween bone volumetric fraction and ridge height and a sta- rior have stable dimensions. The areas of canine and tistically significant negative correlation between trabecu- premolars are varied, because the zone is tasked by chew- lar pattern factor and ridge height [13]. ing function. There are different investigations for evaluation the thickness of facial alveolar bone in frontal area, most of Key words: maxilla, removable prosthesis, bone them with a cone- beam computed tomography [14, 15, 16, anatomy. 17, 18]. Cortical bone thickness of the alveolar wall in different facial type patients (low-angle, normal, and high-an- INTRODUCTION: gle) was the same [19]. Essential for the successful treat- Physiological range of prosthetic field was deter- ment with complete dentures is proper planning, the type mined by the following anatomical structures- spina nasa- of prosthesis and prosthetic design [20]. lis anterior, crista zygomaticoalveolaris, m. buccinators, m. orbicularis oris, m. incisivus labii superioris. In the distal PURPOSE: area this range is placed behind Tuber maxillae to facies The aim of the study was to evaluate the dimensions infratemporalis maxillae [1]. The maxilla contained less la- of maxilla bone in specific removable prosthetics areas. mellar bone compared with the mandible [2]. There are

J of IMAB. 2017 Apr-Jun;23(2) https://www.journal-imab-bg.org 1527 MATERIAL AND METHODS: 2- the distance from lower edge of Foramen infraorbitale The current study was conducted in the Department to the canine’s alveolus (FI-AC); 3- the distance from lower ‘’Anatomy, Histology and Embryology’’, Medical University edge of Foramen infraorbitale to the first premolar’s alveo- of Plovdiv. It was made 160 measurements on sixteen crani- lus (FI-A1P); 4- the distance from lower edge of Foramen ums, and the results were written in individual work cards. infraorbitale to the second premolar’s alveolus (FI-A2P); 5- It was recorded symmetrical dimensions in right and horizontal gap between Tuber maxillae and (Lamina lat- left half: 1- horizontal depth of Spina nasalis anterior (SNA); eralis) Processus pterygoideus (TM-PP) (fig. 1).

Fig. 1. Lateral view of the upper jaw Legend: 1 – Spina nasalis anterior (SNA), 2 – Foramen infraorbitale – alveola dens caninus (FI-AC), 3 – Foramen infraorbitale – alveola dens premolaris primus (FI-A1P), 4 – Foramen infraorbitale – alveola dens premolaris secundus (FI-A2P), 5 – Tuber maxillae - Processus pterygoideus (TM- PP)

It was used Electronic digital caliper 0-150 mm. The results were written in a table (table 1), statistical analysis was made by F-test and Welch t-test, and the study was visu- alized by Microsoft Office Excel 2010.

Table 1. Measurement values on the upper jaw

Ref. marks SNA FI-AC FI-A1P FI-A2P TM-PP No. cranium dex. sin. dex. sin. dex. sin. dex. sin. dex. sin. cranium 1 3,16 3,31 14,78 18,16 17,25 17,75 14,24 16,42 2,07 1,68 cranium 2 4,26 4,15 20,08 20,6 20,3 19,01 20,49 18,22 2,54 2,15 cranium 3 2,38 2,6 21,53 22,05 23,27 24,18 19,93 21,48 1,74 1,98 cranium 4 1,95 1,88 16,35 16,58 16,05 16,64 17,15 15,43 2,15 1,61 cranium 5 2,61 2,8 17,57 17,52 18,69 16,5 19,94 16,73 1,89 1,38 cranium 6 2,59 2,31 17,44 17,31 17,66 15,61 18,53 15,27 1,59 1,18 cranium 7 2,79 1,9 13,3 14,62 15,27 14,77 18,8 16,34 1,63 2,03 cranium 8 2,72 3,04 16,67 15,66 17,58 17,98 19,45 19,38 1,83 1,72 cranium 9 3,77 3,94 13,55 15,19 14,76 15,29 15,3 15,74 1,72 2,03 cranium10 3,99 3,83 12,54 13,33 13,8 14,79 15,39 14,9 1,68 2,02 cranium11 3,03 3,08 14,43 14,89 14,86 15,03 16,34 16,97 1,56 1,7 cranium12 4,75 4,6 16,02 16,77 17,65 18,01 19,8 19,97 2,03 2,16 cranium13 3,75 3,34 16,78 18,2 17,88 17,84 19,62 19,82 2,34 2,46 cranium14 2,06 2,67 19,95 20,94 19,9 21,83 20,46 21,2 1,87 1,98 cranium15 2,42 3,02 16 18,75 15,5 16,05 17,65 18,34 1,24 1,37 cranium16 2,38 2,4 14,26 14,49 15,54 16,18 15,84 17,09 1,67 1,93

RESULTS: language and software environment for statistical comput- Initial data from the symmetrical areas were gathered ing. The purpose of the analysis was to detect statistically in pairs– (SNA dex. - SNA sin), (FI-AC dex.– FI-AC sin.), significant differences between the group means. Consist- (FI-A1P dex.– FI-A1P sin), (FI-A2P dex.– FI-A2P sin.), (TM- ently were applied F-test for equality of variance and PP dex.– TM-PP sin.) and analyzed by “R” programming Welch t-test for comparison group means (Table 2).

1528 https://www.journal-imab-bg.org J of IMAB. 2017 Apr-Jun;23(2) Table 2. Results from F-test and Welch t-test

F-test Welch t-test SNA dex.-SNA sin. F = 1.1175, p-value = 0.8324 t = -0.0569, p-value = 0.955 FI-AC dex.–FI-AC sin. F = 1.045, p-value = 0.9332 t = -0.9603, p-value = 0.3446 FI-A1P dex.–FI-A1P sin. F = 0.8987, p-value = 0.8388 t = -0.105, p-value = 0.9171 FI-A2P dex.–FI-A2P sin. F = 0.9604, p-value = 0.9387 t = 0.473, p-value = 0.6397 TM-PP dex.–TM-PP sin. F = 0.9047,p-value = 0.8488 t = 0.0911, p-value = 0.928

The Range is defined as the difference between the ard deviation is a measure of the spread of the data around maximum and minimum observations, and gives an esti- the mean.The estimated value of standard deviation (sd) mate of the spread of the data. It was highest in FI-A1P, was 2,57/2,51 in FI-AC zone, 2,46/2,59 in FI-A1P zone and followed by FI-AC and FI-A2P. The smallest amplitude was a few smaller 2,08/2,13 in FI-A2P zone. The lowest values established in the TM-PP and SNA. In addition, the stand- were in TM-PP and SNA areas (Table 3).

Table 3. Statistical descriptive parameters

Ref. SNA FI-AC FI-A1P FI-A2P TM-PP marks parameter dex. sin dex. sin. dex sin. dex. sin. dex. sin. mean 3,04 3,05 16,33 17,19 17,25 17,34 18,06 17,71 1,85 1,84 sd 0,83 0,78 2,57 2,51 2,46 2,59 2,08 2,13 0,32 0,34 min 1,95 1,88 12,54 13,33 13,80 14,77 14,24 14,90 1,24 1,18 max 4,75 4,60 21,53 22,05 23,27 24,18 20,49 21,48 2,54 2,46 range 2,80 2,72 8,99 8,72 9,47 9,41 6,25 6,58 1,30 1,28

DISCUSSION: confirms the assumption underlying conservatism of sym- From the results, outlined in Table 2, we conclude metrical areas. The visualization of the percentage is pre- that a statistically significant difference was not found. This sented in Diagram 1.

Diagram 1. Comparative graphics between the mean values of left and right symmetric region

J of IMAB. 2017 Apr-Jun;23(2) https://www.journal-imab-bg.org 1529 Based on both statistical indicators (range, sd) char- premolar and first molar at the alveolar bone level and be- acterizing scattering, we can conclude that areas SNA and tween the first and second molars at the basal bone level TM-PP are more conservative in the course of evolution in the maxilla. Maxillary tuberosity showed the least bone and symmetrically changing. In the variable regions sus- density [5]. ceptible to evolutionary change are FI-A1P, FI-AC and FI- A2P. In determining the cortical thickness, density and elas- CONCLUSION: tic properties, better indicators have been established in Areas of the upper jaw, which are with low density frontomaxillary area, where the grain of the cortical bone (Tuber maxillae) and another with higher density (Spina was aligned vertically from the incisors to the medial ex- nasalis anterior), have similar constancy and stability. In ternal aspect of the orbit [9]. Cortical and cancellous bone the area of the canine and premolars there is variability, density was measured and the result was that the highest related to chewing pressure. cortical bone density was observed between the second

REFERENCES: 1. Popov N, [Clinic of prosthetic dimensional morphometric analysis of alveolar bone overlying healthy max- dentistry. Clinical denturing]. [in Bul- human cadaver bone: Microstructural illary anterior teeth. J Periodontol. garian] Sofia: Medicina i Fizkultura. data from maxilla and mandible. Clin 2012 Feb;83(2):187-97. [PubMed] 1999, 206-9. Oral Implants Res. 2004 Apr;15(2): [CrossRef] 2. Lindhe J, Bressan E, Cecchinato 213-8. [PubMed] 15. Januario AL, Duarte WR, D, Enrico Corra, Toia M, Liljenberg B. 9. Peterson J, Wang Q, Dechow PC. Barriviera M, Mesti JC, Araujo MG, Bone tissue in different parts of the Material properties of the dentate Lindhe J. Dimension of the facial bone edentulous maxilla and mandible. Clin maxilla. Anat Rec A Discov Mol Cell wall in the anterior maxilla: a cone- Oral Implants Res. 2013 Apr;24(4): Evol Biol. 2006 Sep;288(9):962-72. beam computed tomography study. 372-7. [PubMed] [CrossRef] [PubMed] [CrossRef] Clin Oral Implants Res. 2011 Oct; 3. Seong WJ, Kim UK, Swift JQ, 10. Maló P, Rangert B, Nobre M. 22(10):1168-71. [PubMed] [CrossRef] Heo YC, Hodges JS, Ko CC. Elastic All-on-4 immediate-function concept 16. Huynh-Ba G, Pjetursson BE, properties and apparent density of hu- with Brånemark System implants for Sanz M, Cecchinato D, Ferrus J, man edentulous maxilla and mandi- completely edentulous maxillae: a 1- Lindhe J, et al. Analysis of the socket ble. Int J Oral Maxillofac Surg. 2009 year retrospective clinical study. Clin bone wall dimensions in the upper Oct;38(10):1088-93. [PubMed] Implant Dent Relat Res. 2005; 7 Suppl maxilla in relation to immediate im- [CrossRef] 1:S88-94. [PubMed] plant placement. Clin Oral Implants 4. Devlin H, Horner K, Ledgerton 11. Fukuda M, Matsunaga S, Res. 2010 Jan;21(1):37-42. [PubMed] D. A comparison of maxillary and man- Odaka K, Oomine Y, Kasahara M, [CrossRef] dibular bone mineral densities. J Yamamoto M, et al. Three-dimensional 17. Nowzari H, Molayem S, Chiu Prosthet Dent. 1998 Mar;79(3):323-7. analysis of incisive canals in human CHK, Rich SK. Cone Beam Computed [PubMed] [CrossRef] dentulous and edentulous maxillary Tomographic Measurement of Maxil- 5. Chugh T, Ganeshkar SV, bones. Int J Implant Dent. 2015 Dec; lary Central Incisors to Determine Revankar AV, Jain AK. Quantitative as- 1(1):12. [PubMed] [CrossRef] Prevalence of Facial Alveolar Bone sessment of interradicular bone density 12. Guncu GN, Yildirim YD, Yilmaz Width ≥2 mm. Clin Implant Dent Relat in the maxilla and mandible: implica- HG, Galindo-Moreno P, Velasco-Torres Res. 2012 Aug; 14(4):595–602. tions in clinical orthodontics. Prog M, Al-Hezaimi K, et al. Is there a gen- [PubMed] Orthod. 2013 Oct 20;14:38. [PubMed] der difference in anatomic features of 18. Acharya A, Hao J, Mattheos N, [CrossRef] incisive canal and maxillary environ- Chau A, Shirke P, Lang NP. Residual 6. Park HS, Lee YJ, Jeong SH, mental bone? Clin Oral Implants Res. ridge dimensions at edentulous max- Kwon TG. Density of the alveolar and 2013 Sep;24(9):1023-6. [PubMed] illary first molar sites and periodontal basal bones of the maxilla and the [CrossRef] bone loss among two ethnic cohorts mandible. Am J Orthod Dentofacial 13. Monje A, Monje F, Gonzalez- seeking tooth replacement. Clin Oral Orthop. 2008 Jan;133(1):30-7. García R, Suarez F, Galindo-Moreno P, Implants Res. 2014 Dec;25(12):1386- [PubMed] [CrossRef] Garcia-Nogales A, et al. Influence of 94. [PubMed] [CrossRef] 7. Sogo M, Ikebe K, Yang TC, Wada atrophic posterior maxilla ridge height 19. Ozdemira F, Tozlub M, Germec- M, Maeda Y. Assessment of Bone Den- on bone density and microarchitecture. Cakana D. Cortical bone thickness of sity in the Posterior Maxilla Based on Clin Implant Dent Relat Res. 2015 the alveolar process measured with Hounsfield Units to Enhance the Ini- Feb;17(1):111-9. [PubMed] cone-beam computed tomography in tial Stability of Implants. Clin Implant [CrossRef] patients with different facial types. Am Dent Relat Res. 2012 May;14 Suppl 14. Ghassemian M, Nowzari H, J Orthod Dentofacial Orthop. 2013 1:e183-7. [PubMed] [CrossRef] Lajolo C, Verdugo F, Pirronti T, Feb;143(2):190-6. [PubMed] 8. Fanuscu MI, Chang TL. Three- D’Addona A. The thickness of facial [CrossRef]

1530 https://www.journal-imab-bg.org J of IMAB. 2017 Apr-Jun;23(2) 20. Jivraj S, Chee W, Corrado P. Treatment planning of the edentulous maxilla. Br Dent J. 2006 Sep 9; 201(5):261-79; quiz 304. [PubMed] [CrossRef]

Please cite this article as: Shopova D, Bozhkova T, Slavchev D, Muletarov S, Ivanova Z, Bozhikova E. Evaluation of maxillary bone dimensions in specific areas for removable dentures. J of IMAB. 2017 Apr-Jun;23(2):1527-1531. DOI: https://doi.org/10.5272/jimab.2017232.1527

Received: 13/02/2017; Published online: 02/05/2017

Address for correspondence: Dr. Dobromira Shopova, Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University - Plovdiv; 3, Christo Botev Blvd., 4000 Plovdiv, Bulgaria. E-mail: [email protected] J of IMAB. 2017 Apr-Jun;23(2) https://www.journal-imab-bg.org 1531